Novarel — CareFirst (Caremark)
Steroid-refractory acute graft-versus-host disease
Initial criteria
- Requested medication will be taken in conjunction with systemic corticosteroids OR member has an intolerance or contraindication to systemic corticosteroids.
Reauthorization criteria
- All members (including new members) requesting authorization for continuation of therapy must meet all requirements in the coverage criteria section.
Approval duration
12 months